The present report describes a fatal case of imported AIDS-related disseminated histoplasmosis capsulati infection associated with multiple coexisting infections, diagnosed with cultural recovery of Histoplasma capsulatum var. capsulatum with a commercial radiometric Mycobacterium medium. The epidemiological and clinical features of histoplasmosis capsulati and duboisii in Europe are reviewed by examining also 69 documented cases of Histoplasma capsulatum var. capsulatum infection (25 in AIDS patients) and 17 cases of Histoplasma capsulatum var. duboisii infection (3 in HIV-infected patients), described since 1980. This draws special attention to the role played during recent years by the emergence of the HIV pandemic and the progressive intensification of travel and immigration as risk factors for this disease in our continent. AIDS patients, who are prone to multiple concurrent opportunistic infections which may share clinical and laboratory features with each other and with other HIV-associated diseases, represent the most relevant current group at risk for severe disseminated histoplasmosis, which may come to medical attention far from their place of origin.

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Blastoschizomyces capitatus strains resistant to fluconazole were isolated in three cancer patients. All of the strains had identical genomic DNA restriction profiles. Our findings give evidence for the emergence of fluconazole-resistant B. capitatus and suggest a nosocomial acquisition emanating from a common source within the hospital environment.

Candida inconspicua was recovered from three patients with hematological malignancies. Two patients had intravenous-catheter-associated fungemia, whereas the third had fungal hepatitis. The three cases of infection occurred over a period of 1 month in patients staying in adjacent single rooms. In vitro susceptibility testing of fungal strains showed all isolates to be resistant to fluconazole, with MICs greater than 32 μg/ml. All of the strains had identical DNA restriction profiles and randomly amplified polymorphic DNA fingerprints. These data suggest a nosocomially acquired infection emanating from a common source within the hospital environment.

The existence of an area in Europe in which histoplasmosis is endemic was revealed by the isolation of Histoplasma capsulatum from soil. The soil specimen was collected in a chicken yard on a farm near Bologna, Italy. The Emilia-Romagna region had been selected for study because several, apparently autochthonous, human cases of histoplasmosis had originated there.

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We describe the first known case of vertebral osteomyelitis and discitis caused by Blastoschizomyces capitatus in a leukemic patient and the results of therapy. We also reconfirm the microbiological characteristics which differentiate this species from other yeastlike pathogens. Invasive fungal infections are occurring with increasing frequency in immunocompromised patients, particularly those with hematologic malignancies (4). Although most invasive fungal infections are usually caused by Candida, Aspergillus, or Rhizomucor species, several reports have documented the increasing clinical role of Blastoschizomyces capitatus. The pathogenicity of this fungus has been documented in animal models (10), and human infections have involved the lungs (8, 9), endocarditis (2, 5, 22), and disseminated infections (11, 13, 15, 17, 19), the last occurring especially in immunocompromised patients. Although this organism was originally known as Trichosporon capitatum and then Geotrichum capitatum, a recent review recommended the retention of the species in a separate genus, Blastoschizomyces (24). These authors reported that a larger number of systemic infections had been observed in Europe (85% of reported cases) than in the United States or North America (10% of all cases).

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